High-pressure injection injury: Difference between revisions
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==Background== | ==Background== | ||
*Surgical emergency | *Surgical emergency (Amputation rates are as high as 30%) | ||
*Occurs with grease, paint, and fuel guns; usually injected into non-dominant hand | *Occurs with grease, paint, and fuel guns; usually injected into non-dominant hand | ||
*Most important factor is type of injected material | *Most important factor is type of injected material | ||
**Paint produces large, early inflammatory response | **Clean water and air lower risk | ||
**Grease causes small inflammatory response | **Paint produces large, early inflammatory response with high rate of amputation | ||
**Grease causes small inflammatory response with lower rate of amputation | |||
== | ==Clinical Features== | ||
*Most frequently in hand/fingers | |||
*Benign appearance of small injection site in immediate post-injection period is misleading | *Benign appearance of small injection site in immediate post-injection period is misleading | ||
**With time digit becomes edematous, pale, and severely tender to palpation | **With time digit becomes edematous, pale, and severely tender to palpation | ||
*X-ray | |||
==Differential Diagnosis== | |||
{{Hand and finger injury DDX}} | |||
==Evaluation== | |||
*Clinical diagnosis | |||
*Consider X-ray (may show extent of injection of radiopaque substances) | |||
==Management== | ==Management== | ||
*Splint and Elevate | *[[Splint]] and Elevate | ||
*Emergent ortho/hand surgeon consult | *Emergent ortho/hand surgeon consult | ||
* | **Early surgical decompression and debridement | ||
*Early surgical decompression and debridement | **Increased rate of amputation if >10 hours to OR | ||
**> | *[[Tetanus]] | ||
*Tetanus | *[[Antibiotics]] | ||
* | **Targeted at broad spectrum coverage. Traditionally a 3rd generation [[cephalosporin]] | ||
*Analgesia | *[[Analgesia]] | ||
**Digital blocks are contraindicated | **Digital blocks are contraindicated as wound already under high pressure | ||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Hand and finger | *[[Hand and finger injuries]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 00:10, 2 October 2023
Background
- Surgical emergency (Amputation rates are as high as 30%)
- Occurs with grease, paint, and fuel guns; usually injected into non-dominant hand
- Most important factor is type of injected material
- Clean water and air lower risk
- Paint produces large, early inflammatory response with high rate of amputation
- Grease causes small inflammatory response with lower rate of amputation
Clinical Features
- Most frequently in hand/fingers
- Benign appearance of small injection site in immediate post-injection period is misleading
- With time digit becomes edematous, pale, and severely tender to palpation
Differential Diagnosis
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
- Clinical diagnosis
- Consider X-ray (may show extent of injection of radiopaque substances)
Management
- Splint and Elevate
- Emergent ortho/hand surgeon consult
- Early surgical decompression and debridement
- Increased rate of amputation if >10 hours to OR
- Tetanus
- Antibiotics
- Targeted at broad spectrum coverage. Traditionally a 3rd generation cephalosporin
- Analgesia
- Digital blocks are contraindicated as wound already under high pressure
Disposition
- Admit